New Year, New Laws On Prescription Drugs, Charity Care

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On Jan. 1, a host of new laws took effect in Oregon on topics that include health care and industry. 

Many of them are simply housekeeping measures. For example, “nurse midwife nurse practitioners” are now “nurse practitioners specializing in nurse midwifery” and "venereal disease" is now a "sexually transmitted infection." But other laws are more substantive, aiming to protect or at least better inform consumers and regulate the industry. 

Advocates say that one of the most important laws passed during last year’s session is one that targets pharmaceutical companies. The law requires manufacturers to notify the Department of Consumer and Business Services 60 days before a drug price increase above a certain amount. Though the law went into effect on Jan. 1, manufacturers have to report price increases that take effect starting on July 1. The law applies to rises of at least 10 percent or $10,000 a year for brand name drugs and an increase of 25 percent or $300 a year for generics. Companies have to say whether the increase was caused by a change or improvement in the drug and detail those changes. 

Even before the law went into effect, the Pharmaceutical Research and Manufacturers of America, or PhRMA, filed suit against it in addition to a law that went into effect a year ago that requires drug companies to file a report on price hikes. PhRMA filed suit in 2018 against a similar 60-day notification law in California, where the law was seen as putting pressure on drug companies to dial back exorbitant price increases. That case is still going through U.S. District Court in the Eastern District of California.

Another new law that takes in 2021 prohibits pharmacy benefit managers from requiring consumers to use a mail service to fill subscriptions.

Other new laws that just went into effect Jan. 1 address charity care, youth suicide, coordinated care organizations and other issues:

  • Hospitals are now required to provide charity care to low-income residents, paying all or part of the care depending on the patient’s income level. The new floor provides for 100 percent charity care for those who make up to 200 percent of the federal poverty level, which is $24,980 for one person and $51,500 for a family of four.
  • The Oregon Health Authority now has the ability to audit and regulate coordinated care organizations as if they were commercial insurers and requires them to align their financial reporting with the standards set by the National Association of Insurance Commissioners.
  • A new law prevents health insurers from habitually denying prior authorizations for treatment and requires them to give patients a quick thorough explanation behind any denials.
  • Local mental health officials are now required to alert educators, drug and alcohol treatment providers, juvenile authorities and others about the suicide of a person 24 years old or younger, with the aim of them working together to prevent copy cat suicides.
  • Living donors of body parts, such as a kidney, can now take family leave for the procedure and recovery and bans insurers from discriminating against donors by denying coverage, for example.
  • The Public Employees Benefit Board and Oregon Educators Benefit Board are no longer required to offer long-term care insurance to employees and their dependents. Health insurance that covers radiation therapy must now also cover proton beam therapy in a similar way.
  • Employers must give pregnant women reasonable breaks and make other accommodations deemed medically necessary. The new law also forbids discrimination against pregnant women.

Many other laws that were passed during last year's session have already taken effect, including one that allows for workers to take off up to 12 weeks of paid leave to care for a new child or sick family member, or to recover from a serious illness or domestic violence. The time off would be financed by employers and employee contributions to a new state insurance fund. Another law paves the way for an Oregon Health Authority home visits program that will allow families with babies up to six months old to benefit from a visit of a nurse. The visits will be voluntary. And this past summer a law went into effect that allows school-aged children to take mental health days from class.

You can reach Lynne Terry at [email protected]; find her on Twitter @LynnePDX.

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